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Graphical Abstract Access this article Similar content being viewed by others Data Availability The dataset analysed in the current study is not publicly available as this is not approved by the participants within the framework of the general informed consent

patients with symptomatic decline (poor sleep, body composition changes, reduced energy) may be candidates Patients with body composition goals where GH optimization is clinically relevant: body fat accumulation alongside lean mass reduction that has not responded adequately to lifestyle intervention Individuals seeking sleep quality improvement where GH-axis optimization is part of the clinical picture Athletes or active individuals with recovery requirements where GH-mediated protein synthesis is a clinical priority Patients already in a comprehensive longevity program where GH-axis assessment and optimization is part of the protocol The decision to prescribe Ipamorelin or any GH secretagogue begins with a clinical assessment that includes baseline IGF-1 measurement (the primary marker of GH axis activity), review of the patient's symptom profile, and evaluation of contraindications

This approach enables a broad exploration of mechanisms and clinical implications, but it also introduces the potential for selection bias

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